| NPI | 1659538486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A111430) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC ad3189380-cl19) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2012-03-14 |