| NPI | 1902467418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD489726) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 100372) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12664200) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: PA MD489726) | |
| 207X00000X Orthopaedic Surgery (Licence: KS 94-10061) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NJ 25MA12664200) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2025-10-28 |