| NPI | 1790765527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AR C8118) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR C-8118) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2012-04-23 |