| NPI | 1659535912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 34.014277) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: IA 1307020) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2021-03-19 |