| NPI | 1538693858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 315552) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 72434) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-01-05 |