| NPI | 1639130107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 188812) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 188812) |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: NY 188812) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2021-02-26 |