| NPI | 1619362118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S0907) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD17100) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-09-17 |