| NPI | 1093934374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A72688) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A72688) |
| 208D00000X General Practice (Licence: CA A72688) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2017-01-11 |