| NPI | 1700219920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP60962976) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R6961) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2020-11-12 |