| NPI | 1124002449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX L5223) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 34088) |
| 207X00000X Orthopaedic Surgery (Licence: RI MD13114) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2018-04-11 |