| NPI | 1548296841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX P1783) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX P1783) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2005018596) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2019-04-05 |