| NPI | 1063407682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-3825) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA WA0021484) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2007-07-08 |