| NPI | 1649212648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX F6643) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX F6643) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2026-06-25 |