| NPI | 1477908911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD61274579) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: NV 21305) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2026-02-04 |