| NPI | 1568474062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA ML20007563) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A104694) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2011-10-20 |