| NPI | 1780206177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 20A25221) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102207282) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2026-07-02 |