| NPI | 1164486817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 004761) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 005668) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2012-03-21 |