| NPI | 1114941499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 168044-1) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 040965) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2018-05-14 |