| NPI | 1518161496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 168571) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VT 042-0011211) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2015-02-17 |