| NPI | 1619986692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX H5479) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 09332R) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2009-06-16 |