| NPI | 1265878151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD485260) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 28042) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101278477) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: VA 0101278477) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2024-05-28 |