| NPI | 1790980381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD468320) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA MD468320) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2019-07-29 |