| NPI | 1982903142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60476167) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WA MD60476167) |
| Enumeration Date | 2011-03-26 |
| Last Update Date | 2024-05-23 |