| NPI | 1083873186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 56342) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60975590) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2024-11-11 |