| NPI | 1497731780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: FL 151129) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: SC 28473) |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: WV 20792) | |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: OH 35.08143) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-05-24 |