| NPI | 1679759914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 76697) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 184547-1) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 76697) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 184547-1) | |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2015-11-03 |