| NPI | 1629129192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 075294) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61252419) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2025-07-03 |