| NPI | 1659805596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX U3776) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 56665) |
| 207X00000X Orthopaedic Surgery (Licence: SC 40857) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-08-03 |