| NPI | 1619534963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 20A22266) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5151013492) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2024-05-29 |