| NPI | 1982019683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX S1796) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 6806) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-02-23 |