| NPI | 1053395640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35.078735) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 211796-1) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2022-04-19 |