| NPI | 1962405415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 20134) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 32266-020) |
| 207X00000X Orthopaedic Surgery (Licence: MO 108873) | |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2007-10-02 |