| NPI | 1710098660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD00046514) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD00046514) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OR MD26886) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A91046) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-07-21 |