| NPI | 1639198567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME82067) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 208575) |
| 207X00000X Orthopaedic Surgery (Licence: SC 94146) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: SC 94146) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2026-06-30 |