| NPI | 1417972902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 71098) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX G2246) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD459073) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX G2246) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-07-01 |