| NPI | 1164740403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WA MD60630896) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60630896) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2021-03-22 |