| NPI | 1679136915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 32730) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2024-04-30 |