| NPI | 1457373011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CO 46811) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: ND 10155) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 46811) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2008-11-17 |