| NPI | 1114289022 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX R8134) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R8134) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WA MD60733507) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2018-08-27 |