| NPI | 1750677795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 24986) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NV 17254) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CA A-147018) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2022-12-05 |