| NPI | 1124050653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A97281) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 227009) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-12-09 |