| NPI | 1871584276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA G61559) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NV 6395) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2018-08-30 |