| NPI | 1770548810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 208465) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 40208) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: NY 208465) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2024-12-13 |