| NPI | 1386053437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61134797) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD451574) |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2021-08-19 |