| NPI | 1922481803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX T7077) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 85889) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2022-08-07 |