| NPI | 1629059639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A87102) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: CA A87102) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A87102) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2015-09-15 |