| NPI | 1609936475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME101360) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD427446) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2022-01-30 |