| NPI | 1730404286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60476247) |
| Additional Taxonomies | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WA MD60476247) |
| 207X00000X Orthopaedic Surgery (Licence: MN 61416) | |
| Enumeration Date | 2010-03-27 |
| Last Update Date | 2017-10-04 |