| NPI | 1376049734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A164399) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0074628) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MT230522) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2026-09-04 |