| NPI | 1083889539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 249800) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: VA 0101241712) |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2021-10-04 |