| NPI | 1265632988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60366024) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20008976) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2019-07-25 |