| NPI | 1659300044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 6209402-1205) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: UT 6209402-1205) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-12-20 |