| NPI | 1306924030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A46350) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 27335) |
| 207R00000X Internal Medicine (Licence: NV 27335) | |
| 207Q00000X Family Medicine (Licence: NV 27335) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2026-01-23 |