| NPI | 1043621063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 303356) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 2019-00101) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2020-07-23 |