| NPI | 1831245513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 045129) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD60213681) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD60213681) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2019-06-05 |