| NPI | 1518979418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 20A7594) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA 20A7594) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2013-03-21 |