| NPI | 1366559163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60270460) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD60270460) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-09-17 |