| NPI | 1962723791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: TX P7418) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME122526) |
| 207X00000X Orthopaedic Surgery (Licence: TX P7418) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10037392) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2023-08-03 |