| NPI | 1770576993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD427153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101243739) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2025-08-14 |