| NPI | 1700074127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA C130501) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 6099535-1205) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2020-08-26 |