| NPI | 1588668974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD072063L) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101242016) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2013-01-29 |