| NPI | 1053608216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A167146) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301116263) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A167146) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2021-03-11 |