| NPI | 1871559518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 49508) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 49508) |
| 207X00000X Orthopaedic Surgery (Licence: TN MD26989) | |
| 207X00000X Orthopaedic Surgery (Licence: GA 049508) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2025-09-16 |