NPI | 1902434632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61667437) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD61667437) |
Enumeration Date | 2020-03-30 |
Last Update Date | 2025-06-05 |