| NPI | 1093342248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WA MD.70018281) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD.70018281) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-06-18 |