| NPI | 1083857593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 272792) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 272792) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2020-03-07 |