| NPI | 1124230479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60311813) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WI 54588) |
| 208600000X Surgery (Licence: NC 2008-01727) | |
| 208600000X Surgery (Licence: CA A93061) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-03-01 |