| NPI | 1235179300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: CO 47915) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX E6283) |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: TX E6283) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX E6283) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CO 47915) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2015-11-24 |