| NPI | 1154531622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301085596) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX P0597) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2019-03-14 |