NPI | 1679603401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60090624) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 117987) |
Enumeration Date | 2007-03-07 |
Last Update Date | 2021-06-17 |