| NPI | 1811209075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX G0086531-00122) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT013745) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2019-03-29 |