| NPI | 1700858651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD46465) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 224254) |
| Enumeration Date | 2006-02-05 |
| Last Update Date | 2009-02-03 |