| NPI | 1578555264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD00037662) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ID M12512) |
| 207X00000X Orthopaedic Surgery (Licence: ID TLM-4023) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-06-02 |