| NPI | 1700204922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 307499) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VT 042.0014602) |
| 207X00000X Orthopaedic Surgery (Licence: NH 19790) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2025-12-01 |