| NPI | 1861774291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID O0947) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: ID O0947) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: WA OP60637340) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA OP60637340) | |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2025-09-10 |