| NPI | 1063614584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N9877) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2010025675) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD436380) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2022-07-21 |