| NPI | 1760554091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 04-30731) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: OH 35.144533.MIL) |
| 207X00000X Orthopaedic Surgery (Licence: CO 54603) | |
| 207X00000X Orthopaedic Surgery (Licence: MO 2010031657) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2026-07-02 |