| NPI | 1346683059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KY 52379) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MO 2018007986) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2019-06-20 |