NPI | 1558752212 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A166363) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A166363) |
Enumeration Date | 2015-02-16 |
Last Update Date | 2024-08-30 |