| NPI | 1780667865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TN 37747) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2005-00744) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2011-03-22 |