| NPI | 1104856087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M9722) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00044939) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2026-06-24 |