| NPI | 1790009264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WA MD60540419) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60540419) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2021-11-02 |