| NPI | 1821290446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX N3968) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX 54060) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-05-28 |