| NPI | 1710965116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: PA MD420020) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX L9632) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD420020) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2019-03-04 |