| NPI | 1306132360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 50671) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60637982) |
| 207X00000X Orthopaedic Surgery (Licence: GA 4848) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2022-07-21 |