| NPI | 1720388051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101253537) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2024-07-30 |