| NPI | 1457350878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 40911) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ME MD19206) |
| 207X00000X Orthopaedic Surgery (Licence: TX D1080) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-02-27 |