| NPI | 1134501604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX T8000) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 308423) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX T8000) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-04-04 |