| NPI | 1588867394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60365964) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD60365964) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2013-09-03 |