| NPI | 1134569908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 51770) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IN 01081117A) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-03-13 |