| NPI | 1760695449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N2329) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX AP 2247799-54061) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2019-03-29 |