| NPI | 1972940872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A132691) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 278393) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A132691) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2023-01-17 |