NPI | 1154700862 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD226288) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 29377) |
171000000X Military Health Care Provider | |
207X00000X Orthopaedic Surgery (Licence: CA C179913) | |
Enumeration Date | 2015-05-27 |
Last Update Date | 2025-09-26 |