| NPI | 1982648713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: DC 22105) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D42000) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-10-24 |