| NPI | 1255712741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 22741) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 307847) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-01-18 |