| NPI | 1457970832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NY 319008) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: GA 104035) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2026-05-11 |