| NPI | 1902208440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX Q3076) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME121143) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2024-06-20 |