| NPI | 1154680486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX T3482) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T3482) |
| 207X00000X Orthopaedic Surgery (Licence: CA A126999) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX T3482) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2024-11-08 |