| NPI | 1619035524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101019813) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D54601) |
| 207X00000X Orthopaedic Surgery (Licence: WA MD31536) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2010-06-22 |