| NPI | 1629085519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 66572-20) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OR MD21166) |
| 207X00000X Orthopaedic Surgery (Licence: WA MD60431541) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-04-03 |