| NPI | 1245783976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 112210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31535) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2026-04-23 |