| NPI | 1972703908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60125328) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 80869) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2009-00916) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2010-11-19 |