| NPI | 1740487149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX M8348) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101241007) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2022-05-04 |