| NPI | 1740447747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N4797) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX N4794) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME102695) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2012-04-02 |