| NPI | 1710245071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MO 2017006727) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60846830) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2018-12-11 |