| NPI | 1053397901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID 8971254) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00036954) |
| 207X00000X Orthopaedic Surgery (Licence: MN 43285) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2025-09-10 |