| NPI | 1558353706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 34.014723) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX G5430) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2026-06-03 |