NPI | 1720449820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA 61488713) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 1720449820) |
Enumeration Date | 2016-03-16 |
Last Update Date | 2024-07-29 |