| NPI | 1790983476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: WA MD60263519) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60263519) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2014-09-18 |