| NPI | 1275859480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD458354) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: CO 60987) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CO 60987) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2021-02-06 |