| NPI | 1104146554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX S3671) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D81386) |
| 207X00000X Orthopaedic Surgery (Licence: GA 85102) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2020-11-09 |