| NPI | 1053451567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL 159511) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 1586761) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-11-15 |