| NPI | 1548429525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME124439) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 69974) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT190619) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.099357) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 45348) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2025-07-28 |