| NPI | 1972963676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.154123) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA 61281791) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2025-07-01 |