| NPI | 1275597270 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD071095L) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD071095L) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2019-11-22 |