| NPI | 1538153747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA G35078) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ME MD19645) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2018-11-01 |