| NPI | 1023196052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: FL ME71177) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11797) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-03-25 |