| NPI | 1962792952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A149744) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NV 17131) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2025-07-16 |