| NPI | 1124019591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA C29083) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 3279) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2010-10-04 |