| NPI | 1861604217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP00002294) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101015498) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2008-08-19 |