| NPI | 1437195377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101255623) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00026111) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD0002611) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2023-03-07 |