| NPI | 1710542667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VA 0101285323) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA MD61526149) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WA MD61526149) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: VA 0101285323) | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-10-16 |