| NPI | 1194728709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: WA MD00028221) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD00028221) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2011-05-12 |