| NPI | 1194990895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 235713) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 1021) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2016-03-03 |