| NPI | 1639245129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA G44435) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA 23873) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2011-10-01 |