| NPI | 1285833244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 60764) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D0104820) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD493343) | |
| 207X00000X Orthopaedic Surgery (Licence: WV 34231) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2026-01-23 |