| NPI | 1295350718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 335727) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5151014547) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2025-05-05 |