| NPI | 1467486712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: PA MD433764) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MD433764) |
| 207X00000X Orthopaedic Surgery (Licence: OH 35-083386) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2026-04-27 |