| NPI | 1952514994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 7724) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 5000) |
| 207X00000X Orthopaedic Surgery (Licence: MN 51596) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2011-06-24 |