| NPI | 1134581200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WI 22517) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT210600) |
| 207X00000X Orthopaedic Surgery (Licence: WI 77262-20) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2025-08-07 |