| NPI | 1205037561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A102466) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 49621) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2012-03-13 |