| NPI | 1184363129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 35709) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A203848) |
| Enumeration Date | 2022-05-28 |
| Last Update Date | 2026-02-23 |