| NPI | 1780618926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA G32805) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CA G32805) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA G32805) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-12-03 |