| NPI | 1124446869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY FL048) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA TR 60540337) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-01-11 |