| NPI | 1194345124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 340999) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO 0075067) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2026-07-31 |