| NPI | 1790906543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: NC 2010-00736) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2010-00736) |
| 207X00000X Orthopaedic Surgery (Licence: TX N2317) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX N2317) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-04-13 |