| NPI | 1114909009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD048632L) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2004-00374) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2021-09-10 |