| NPI | 1366431249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60084905) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35-090958) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2020-12-07 |