| NPI | 1477608875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: ID M-12753) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID M-12753) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD60535289) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-03-31 |