| NPI | 1477874873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX Q0422) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10037389) |
| 207X00000X Orthopaedic Surgery (Licence: MA 261836) | |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2016-10-18 |