| NPI | 1962450700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX G4679) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM 94-352) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2019-06-18 |