| NPI | 1962815886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A159063) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61019205) |
| 207X00000X Orthopaedic Surgery (Licence: AZ R74452) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-09-17 |