| NPI | 1639302623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 346299) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA ot013120) |
| 207X00000X Orthopaedic Surgery (Licence: WI 61724-21) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2026-08-26 |