| NPI | 1811998842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME95144) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 050868) |
| 207X00000X Orthopaedic Surgery (Licence: TX M1028) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2020-11-16 |