| NPI | 1720379050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60755247) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: CA A140698) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2021-06-16 |