| NPI | 1114284288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 271301) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 272781) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2019-08-11 |