| NPI | 1639483522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME159674) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 052337) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: CT 052337) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CT 052337) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2023-03-03 |