| NPI | 1649217324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 43139) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 34272) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CO 43139) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-01-14 |