| NPI | 1134501463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WA 61294202) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A172724) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD470045) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2022-09-13 |