| NPI | 1386835585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: TX Q6009) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: NM MD2014-0304) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: MO 2016027259) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-06-03 |