| NPI | 1740373133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: NY 251603-1) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 251603-1) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 015519) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2022-08-21 |