| NPI | 1962961102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 13865896-1205) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery Pediatric Orthopaedic Surgery (Licence: UT 13865896-1205) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-03-09 |