| NPI | 1750688396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 272860) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 67594) |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2021-07-30 |