| NPI | 1023301090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP61427005) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0102203619) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2023-10-06 |