| NPI | 1558449579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA 950394) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 20A81676) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-01-03 |