| NPI | 1730130493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ND 4392) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX e7658) |
| 207X00000X Orthopaedic Surgery (Licence: MN 22896) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-03-25 |