| NPI | 1790762615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX L6057) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX L6057) |
| 213E00000X Podiatrist (Licence: TX L6057) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX L6057) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2023-01-28 |