| NPI | 1770699159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WA MD60217236) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA ML20008199) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2010-00363) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-09-02 |