| NPI | 1003806373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 204628-2) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 215567) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2008-06-10 |