| NPI | 1033264957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA PA10004471) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004471) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2009-05-29 |