| NPI | 1235211145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA G65796) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA G65796) |
| 174400000X Specialist (Licence: CA G65796) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2009-06-04 |