| NPI | 1922200468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 45545) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT186736) |
| 207X00000X Orthopaedic Surgery (Licence: NC 2011-00878) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2025-04-21 |