| NPI | 1902814114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2021-02948) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD060967L) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2022-06-06 |