| NPI | 1982097705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA OP61257172) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WA OP61257172) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2022-06-08 |