| NPI | 1093246290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0074023) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 321571) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A174992) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2026-07-26 |