| NPI | 1336532332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S7398) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2021-0199) |
| 208D00000X General Practice (Licence: NE 29607) | |
| Enumeration Date | 2015-03-15 |
| Last Update Date | 2021-06-14 |