| NPI | 1821071044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 57734) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: GA 57734) |
| 207X00000X Orthopaedic Surgery (Licence: SC MD30266) | |
| 207X00000X Orthopaedic Surgery (Licence: NC 2004-01658) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2019-10-30 |