| NPI | 1548654783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA T288143) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD17624) |
| 207X00000X Orthopaedic Surgery (Licence: NY 303371) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-09-15 |