| NPI | 1538310214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME117110) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA Md438698) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.099835) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2026-04-01 |