| NPI | 1700875176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 70680) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA 70680) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX Q2309) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2017-09-19 |