| NPI | 1831459031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: TX R3598) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX R3598) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2026-05-19 |