| NPI | 1548621469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX 282512) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX t6293) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX 282512) | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX T6293) | |
| 207X00000X Orthopaedic Surgery (Licence: OR 0000) | |
| Enumeration Date | 2016-03-20 |
| Last Update Date | 2022-07-12 |