| NPI | 1689851354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 8234797-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 246370) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2026-05-22 |