| NPI | 1134386592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MS 21698) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A108853) |
| 207X00000X Orthopaedic Surgery (Licence: TN 45803) | |
| 207X00000X Orthopaedic Surgery (Licence: TX W0354) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2025-10-08 |