| NPI | 1639332539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60457002) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ R70624) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A126143) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-09-27 |