| NPI | 1306108436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60925841) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD459892) |
| 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: WA MD60925841) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2019-10-30 |