| NPI | 1154374734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: VT 42-0011585) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 200400468) |
| 207X00000X Orthopaedic Surgery (Licence: VT 42-0011585) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-09-25 |