| NPI | 1770795262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD 60320264) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: WA MD 60320264) |
| 207X00000X Orthopaedic Surgery (Licence: OR MD151268) | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: OR MD151268) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-10-23 |