| NPI | 1093797367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA C54254) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101102750) |
| 207X00000X Orthopaedic Surgery (Licence: GA 57605) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2020-02-17 |