| NPI | 1649659319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: FL ME169918) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL Q620-008-81-309-0) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2024-08-08 |