| NPI | 1487917720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD D0086198) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 61438-20) |
| 207X00000X Orthopaedic Surgery (Licence: WI 61438-20) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-04-29 |