| NPI | 1326327552 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A150179)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101259588)  | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-05 | 
| Last Update Date | 2018-08-07 |