| NPI | 1578742433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 1843141) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 184314) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2020-12-18 |