| NPI | 1770798647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61140852) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WA MD61140852) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2021-04-13 |