| NPI | 1548617442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 13312643-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PR 23134) |
| 208D00000X General Practice (Licence: PR 14450) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2024-03-15 |