| NPI | 1851894265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MS 32137) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208D00000X General Practice (Licence: AZ 58321) | |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2023-12-28 |