| NPI | 1184887291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 2013-00934) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 2389551) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2021-05-06 |