| NPI | 1962765222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OR PG158100) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 14175036-1204) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: ID O-1152) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2025-06-05 |