| NPI | 1669851416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: NE 29393) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: NC 2020-02932) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2022-08-23 |