| NPI | 1457467789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX H1124) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 20301) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2019-08-12 |