| NPI | 1811201403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 280422) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT198180) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2016-04-19 |