| NPI | 1154464154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 18186) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 18186) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2009-12-14 |