| NPI | 1093133670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 329517) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SD 12515) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-06-13 |