| NPI | 1629415682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD467204) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA 207X00000X) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD467204) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 51607) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2021-07-05 |