| NPI | 1902805591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: RI MD) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 038455) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2013-09-12 |