| NPI | 1639197841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD00033967) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 18328) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD00033967) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 18328) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |