| NPI | 1588664783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD15845) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60528242) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2015-02-16 |