| NPI | 1548558273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R3783) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT199870) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2019-08-16 |