| NPI | 1659502813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A158190) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD453726) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A158190) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2021-12-03 |