| NPI | 1386644953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX G0143) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AR R3725) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2021-06-23 |