| NPI | 1700409133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 324015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-3649) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2024-07-31 |