| NPI | 1023089752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD00040962) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00040962) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2019-07-12 |