| NPI | 1659508299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60657218) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60657218) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2016-10-18 |