| NPI | 1144219510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX P4504) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101238201) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2023-05-30 |