| NPI | 1124010491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA MD419522) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD419522) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2014-01-16 |