| NPI | 1982645719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: AZ 4402) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 4402) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2014-02-10 |