| NPI | 1558417824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA C38056) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301034742) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-09 |