| NPI | 1649769522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX V0882) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10063180) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME162579) | |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2024-10-01 |