| NPI | 1083243695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NM MD2026-0305) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61668004) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WA MD61668004) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD61668004) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-07-03 |