| NPI | 1578980660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S5229) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 82573) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX S5229) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 581974) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2020-09-01 |