| NPI | 1508977893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX M6447) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM 2001-117) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-04-30 |