| NPI | 1730538935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A175015) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2024-08-15 |