| NPI | 1356705669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61266815) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 218845) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD61266815) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-08-29 |