| 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 |