| NPI | 1770920472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A153261) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 256175) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2020-03-20 |