| NPI | 1558627091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD454303) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10718600) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: PA MD454303) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-07-17 |