| NPI | 1053653360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX S1864) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D86505) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2022-02-28 |