| NPI | 1124220595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 49674) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A111830) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 49674) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2011-08-16 |