| NPI | 1801853148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX D7763) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2013-0185) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2014-09-09 |