NPI | 1134581200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WI 22517) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT210600) |
207X00000X Orthopaedic Surgery (Licence: WI 77262-20) | |
Enumeration Date | 2016-03-28 |
Last Update Date | 2022-12-05 |