| NPI | 1619917408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: FL ME80331) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 281137) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2026-01-07 |