| NPI | 1811176647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A100920) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA A100920) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2020-08-26 |