| NPI | 1750769170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S5818) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 80339) |
| 207X00000X Orthopaedic Surgery (Licence: CA A151259) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2020-04-08 |