| NPI | 1255374740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: OR 23061) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR 23061) |
| 207Q00000X Family Medicine (Licence: OR MD23061) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-06-07 |