| NPI | 1063668747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO DR0053689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL0580) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: OH 34010234) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2014-07-25 |