| NPI | 1992763494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 39813) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: KY 39813) |
| 174400000X Specialist (Licence: KY 39813) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-12-09 |