| NPI | 1164743035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 320811) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA 60746942) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2025-08-11 |