| NPI | 1174648703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60001018) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A88959) |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: WA MD60001018) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2011-12-07 |