| NPI | 1518320142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX R9500) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R9500) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-09-29 |