| NPI | 1164603866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R6119) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX R6119) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2022-06-03 |