| NPI | 1124095799 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX M1491) | 
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: TX M1491) | 
| Enumeration Date | 2006-03-02 | 
| Last Update Date | 2021-01-24 |