| NPI | 1114103082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP00002177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 00178475) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2008-01-10 |