| NPI | 1760638324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CT 53148) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: DC in training) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: MI 4301102407) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2017-02-27 |