| NPI | 1619970316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX E0658) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 13254) |
| 207X00000X Orthopaedic Surgery (Licence: NC 15837) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2014-05-23 |