| NPI | 1609949510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA G82031) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA G42239) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA G82031) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2010-07-23 |