| NPI | 1467454397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 28790) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 28790) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KY 28790) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2015-02-23 |