| NPI | 1235244054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD00047258) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 46308) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-04-04 |