| NPI | 1730475542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX R4654) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 20a12417) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2019-08-05 |