| NPI | 1528258738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A124053) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60287523) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2021-11-08 |