| NPI | 1992238257 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: CA NA) | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CA Pending) | 
| Enumeration Date | 2017-04-04 | 
| Last Update Date | 2025-09-29 |