| NPI | 1467650077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD d75966) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: TX Q1644) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2024-02-27 |