| NPI | 1891297016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX U4174) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2018-03-03 |
| Last Update Date | 2023-08-22 |