| NPI | 1225561939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A177935) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 74344) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 74344) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2025-08-08 |