| NPI | 1982821898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 10219) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX P0036) |
| 207X00000X Orthopaedic Surgery (Licence: MI 5101016956) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2019-10-31 |