| NPI | 1629606249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD.MD.70135509) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 76078) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WA MD.MD.70135509) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-09-10 |