| NPI | 1063943025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX S8245) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A176312) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-05-26 |