| NPI | 1073518197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX L2837) |
| Additional Taxonomies | 174400000X Specialist (Licence: L2837) |
| 207X00000X Orthopaedic Surgery (Licence: TX L2837) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2025-09-16 |