| NPI | 1730987637 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 66102) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA66102) |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2025-03-19 |