| NPI | 1073769626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 269411) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NY 269411) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2024-03-18 |