| NPI | 1205029477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP60218317) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR DO187246) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25IB12849700) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2025-12-03 |