| NPI | 1275812059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A141601) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT200397) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2022-02-11 |