| NPI | 1639516107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S1043) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10046142) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2020-11-06 |