| NPI | 1770011835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX U4867) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2022-00840) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2023-11-03 |