| NPI | 1154360303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 466) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA OP60795331) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2019-04-05 |