| NPI | 1073046967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 10959182-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61260393) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2025-12-03 |