| NPI | 1336305291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301504894) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 275201) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2021-07-13 |