NPI | 1629738158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A175836) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 175836) |
Enumeration Date | 2021-12-24 |
Last Update Date | 2022-08-04 |