| NPI | 1366705014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC 34861) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60727890) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2021-05-23 |