| NPI | 1992775084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 76197) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NH 12038) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-02-13 |