| NPI | 1659781763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 5291674-1204) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV DO3014) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2021-11-17 |