| NPI | 1982697959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD477714) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WA MD61047550) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME88204) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD477714) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2025-10-05 |