| NPI | 1093705063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 15126R) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 35090817) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: OH 35090817) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2011-03-18 |