| NPI | 1104037316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 266497) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL TRN-8938) |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2023-03-13 |