| NPI | 1972917276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD D87842) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: OK 30774) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: MD D87842) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-06-22 |