| NPI | 1164785713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA 20A13167) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2016-01-18 |