| NPI | 1114555661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A202108) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351045994APP20) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-07-10 |