| NPI | 1003071234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 274278) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PENDING) |
| 207X00000X Orthopaedic Surgery (Licence: RI 14215) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2014-11-25 |