| NPI | 1275686610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 81196) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 23998) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: SD 12187) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: TX N6752) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-07-25 |