| NPI | 1093001323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2021-01484) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX Q6586) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2021-09-08 |