| NPI | 1194870766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA MD476395) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207X00000X Orthopaedic Surgery (Licence: PA MD476395) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: VA 0101242414) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2024-07-05 |