| NPI | 1790165447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: UT 11741853-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301107989) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-04-29 |