| NPI | 1679003263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 321744) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: RI MD18292) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-07-31 |