| NPI | 1972867562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A153579) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 251570) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-08-09 |