| NPI | 1972833705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD008780E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD008780E) |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2009-12-29 |