| NPI | 1710106653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 8628563-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA 60281365) |
| 207X00000X Orthopaedic Surgery (Licence: OR MD157460) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-07-21 |