| NPI | 1083064968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KY 56762) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: KY 56762) |
| 207X00000X Orthopaedic Surgery (Licence: MI 4301117434) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CO DR.0065760) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-12-05 |