| NPI | 1356847370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61655589) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX U9234) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2025-04-21 |