| NPI | 1104879014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA G85091) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA G85091) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-10-22 |