| NPI | 1861629537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD446860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD446860) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD446860) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-07-27 |