| NPI | 1386082725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 35819) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX S1241) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0060454) | |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2021-08-16 |