| NPI | 1558300731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: PA MD060854L) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 310389) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME152626) | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NJ 25MA06889500) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-02-25 |