| NPI | 1558316703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60466942) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MT 11094) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2025-05-21 |