| NPI | 1487759650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 309292) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME132909) |
| 207X00000X Orthopaedic Surgery (Licence: GA 28054) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-10-19 |