| NPI | 1154700862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA C179913) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: NE 29377) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2024-06-24 |