| NPI | 1003811811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 132580) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NY 132580) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2011-06-06 |