| NPI | 1902953607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX F6553) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX F6553) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-09-10 |