| NPI | 1154771657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX T8499) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 7673) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2022-08-03 |