| NPI | 1699290775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD465993) |
| Additional Taxonomies | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: FL 207XP3100X) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2021-07-05 |