| NPI | 1982678256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX G4968) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX G4968) |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: TX G4968) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2012-09-18 |