| NPI | 1619139011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: NY 251921-1) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: PA MD433437) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2017-02-24 |