| NPI | 1568800431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 11732540-1204) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 20A24049) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2025-12-08 |