| NPI | 1962595082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60548172) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WY 8176A) |
| 207X00000X Orthopaedic Surgery (Licence: UT 1733941205) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-01-14 |