| NPI | 1104822790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 62948) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX HI505) |
| 207X00000X Orthopaedic Surgery (Licence: MO R4c36) | |
| 207X00000X Orthopaedic Surgery (Licence: OK 13864) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2021-09-13 |