| NPI | 1124027479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX MDG1331) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA MD203742) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2020-08-24 |