| NPI | 1649532078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S3495) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10044421) |
| 208600000X Surgery (Licence: MN 63789) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2019-12-02 |