| NPI | 1346483518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME107667) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 234696) |
| 207X00000X Orthopaedic Surgery (Licence: NY 003783) | |
| 207X00000X Orthopaedic Surgery (Licence: NY P47466) | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2021-10-21 |