| NPI | 1679983712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: TX S6278) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CA A161017) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2020-12-10 |