| NPI | 1659808467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD 3090) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 3090) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |