| NPI | 1629203229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: WV 24595) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD452251) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2022-04-12 |