| NPI | 1154324705 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR MD27700)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA G81021)  | 
| Enumeration Date | 2005-05-27 | 
| Last Update Date | 2022-01-25 |