| NPI | 1841561750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KS 04-36640) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: MO 2013026061) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2013026061) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KS 04-36640) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2022-09-30 |