| NPI | 1164763306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CT 53277) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 53277) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2021-04-28 |