| NPI | 1912360272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61191259) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MDRE.ML.60653710) |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2023-01-05 |