| NPI | 1497045991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 282993) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD 4052) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2017-05-04 |