| NPI | 1790737690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 42968) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101239676) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-09-25 |