| NPI | 1164785754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 295962) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT014869) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0102204768) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-01-25 |