| NPI | 1780747287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 64770) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A64770) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA 64770) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2015-10-14 |