| NPI | 1609165448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 5101022147) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 20A13575) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 62342) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2020-07-31 |