| NPI | 1063495133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 68258) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 169768) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2017-12-28 |