| NPI | 1285644195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA 37180) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID M8045) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2025-08-04 |