| NPI | 1457848665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CT 79852) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 79852) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2026-05-11 |