| NPI | 1134479736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.130276) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: OH 35.130276) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD449760) | |
| 207X00000X Orthopaedic Surgery (Licence: PA MD449760) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MT201805) | |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2026-01-15 |