| NPI | 1477709103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 54955) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A110737) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2025-01-02 |