| NPI | 1174784896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 67489) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 254107) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: NY 254107) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CT 67489) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-03-30 |