| NPI | 1720019060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WY 10960A) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX L9715) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX L9715) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-09-25 |