| NPI | 1164983250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 334152) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 334152) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-04-16 |