| NPI | 1972742567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2009026150) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IA 38175) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2009-10-15 |