| NPI | 1386273712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD.MD.70116065) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WA MD.MD.70116065) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2026-08-12 |