| NPI | 1770015125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD216580) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61466509) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2026-07-23 |