| NPI | 1497074876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: GA 76102) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OH 34.011328) |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: AL DO.1629) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2020-11-19 |