| NPI | 1831451913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 76684) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10044422) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2024-07-25 |