| NPI | 1821351875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A126302) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 10785573-1205) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2022-02-11 |