| NPI | 1619110673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N9306) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL Me109240) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2020-11-05 |