| NPI | 1629025994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD072865L) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME152503) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09116600) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2021-11-08 |