| NPI | 1225327364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP60870076) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 816) |
| 207X00000X Orthopaedic Surgery (Licence: NE 816) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2018-08-07 |