| NPI | 1376037895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 321558) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 8327) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2025-07-15 |