| NPI | 1962452524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 5101014863) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 044107) |
| 207X00000X Orthopaedic Surgery (Licence: NY 238944) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-02-19 |