| NPI | 1982848099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A120817) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 57.013999) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2019-09-03 |