| NPI | 1063705804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A122153) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: CA A122153) |
| 207X00000X Orthopaedic Surgery (Licence: CA A122153) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2024-04-28 |