| NPI | 1760492656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M6567) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA 31851) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2015-08-04 |