| NPI | 1679869515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 145413) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 247600) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-01-04 |