| NPI | 1821358904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CA A147175) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R2888) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2023-03-25 |