| NPI | 1831639780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP61407863) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX W1467) |
| 207X00000X Orthopaedic Surgery (Licence: MI 5101023218) | |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2026-02-24 |