| NPI | 1649596933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA A119788) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD454724) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09697700) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2026-06-05 |