| NPI | 1659551216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N9955) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA MD.201428) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N9955) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35095328) | |
| Enumeration Date | 2007-11-11 |
| Last Update Date | 2024-02-06 |