| NPI | 1740257542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A79561) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX K2785) |
| 207X00000X Orthopaedic Surgery (Licence: CO DR38255) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2023-05-11 |