| NPI | 1609039213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 25549) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: NH 18885) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2020-03-04 |