| NPI | 1366076283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 20A20314) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A20314) |
| Enumeration Date | 2020-02-29 |
| Last Update Date | 2025-08-01 |