| NPI | 1104833177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX P3957) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM 2004-0335) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2019-03-05 |