| NPI | 1568881332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.128094) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD467195) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-11-10 |