| NPI | 1457197832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX SA00917) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: TX SA00917) |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TX SA00917) | |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2025-01-17 |