| NPI | 1548431158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD60462965) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VT 060-0003612) |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: TX P5372) | |
| 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: WA MD60462965) | |
| Enumeration Date | 2008-03-22 |
| Last Update Date | 2014-08-27 |