| NPI | 1861712218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 26143) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX N2959) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX N2959) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NE 26143) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2011-08-18 |