| NPI | 1396364121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A200612) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA 0259) |
| Enumeration Date | 2020-04-12 |
| Last Update Date | 2025-08-01 |