| NPI | 1831490135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD PA78442) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD PA78442) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2023-02-03 |