| NPI | 1710307947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61053789) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 278630) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2021-05-12 |