| NPI | 1992966493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: WI 53408) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: AZ 55350) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2024-02-07 |