| NPI | 1417108457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: DC MD040322) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A113971) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MD D0073732) | |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2012-08-08 |