| NPI | 1861744419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A126849) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R1692) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2022-07-21 |