| NPI | 1043414741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60619770) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR MD29095) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2021-06-30 |