| NPI | 1861693939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 1029) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 1029) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2013-03-26 |