| NPI | 1396271656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 30941) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 300456) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2022-11-28 |