| NPI | 1508355983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 23069) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CA 23069) |
| 207X00000X Orthopaedic Surgery (Licence: NY 323012-01) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2024-08-15 |