| NPI | 1093192718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: OH 35.138931) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 41937) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2020-04-29 |