| NPI | 1548528573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35134940) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WA MD60763576) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2019-11-06 |