| NPI | 1053512574 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 269870) | 
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NY 269870) | 
| Enumeration Date | 2007-05-31 | 
| Last Update Date | 2013-05-16 |