| NPI | 1982863254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OK 30856) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX BP10032048) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2015-03-19 |