| NPI | 1508095431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA 60465652) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 66410) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2014-07-17 |