| NPI | 1639431661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R1502) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KS 94-07982) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2018-01-31 |