| NPI | 1861408254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 058278) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 058278) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A78560) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-04-30 |