| NPI | 1588945794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX P0998) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10031907) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2025-05-22 |