| NPI | 1639325855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME134744) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX Q3273) |
| 207X00000X Orthopaedic Surgery (Licence: MN 53149) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2018-09-12 |