| NPI | 1578887691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NY 266294) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 266294) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2023-07-07 |