| NPI | 1518278969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX TX3536) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SD 10367) |
| 207X00000X Orthopaedic Surgery (Licence: MN 55430) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2026-06-24 |