NPI | 1104272574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0102207700) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA OP61112868) |
Enumeration Date | 2016-05-04 |
Last Update Date | 2023-10-03 |