| NPI | 1962697177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2011-0073) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35.088474) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2012-07-25 |