| NPI | 1679929871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 289792) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R75527) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2022-07-21 |