| NPI | 1467650077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: MD D75966) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD d75966) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2025-02-05 |