| NPI | 1811255524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 69899) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10043278) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2018-10-03 |