| NPI | 1720309453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WA OP60709060) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA OP60709060) |
| 207X00000X Orthopaedic Surgery (Licence: WA OP60709060) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2016-12-19 |