| NPI | 1346465119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 8228386-1205) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: MO 2011001617) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2021-09-23 |