| NPI | 1124355300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD443424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD443424) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2013-08-15 |