| NPI | 1699952119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO 0047682) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 238334) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2025-12-05 |