| NPI | 1184697211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60501825) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 22965) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60501825) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2023-01-05 |