| NPI | 1790797504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NV 5164) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 26261) |
| 207X00000X Orthopaedic Surgery (Licence: ND 11238) | |
| 207X00000X Orthopaedic Surgery (Licence: WA MD60095213) | |
| 207X00000X Orthopaedic Surgery (Licence: TX N7439) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2010-10-20 |