| NPI | 1629368527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R3705) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 62288) |
| 207X00000X Orthopaedic Surgery (Licence: NE 27178) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2020-05-07 |