| NPI | 1174977508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 56795) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX T2205) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-11-08 |