| NPI | 1487101945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A209046) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4351048258) |
| 183500000X Pharmacist (Licence: CO 0021483) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2026-07-27 |