| NPI | 1689629081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 10274441-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL TRN18020) |
| 2251X0800X Physical Therapist Orthopedic (Licence: FL PT 22672) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-11-02 |