| NPI | 1780827022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 246675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME148197) |
| 207X00000X Orthopaedic Surgery (Licence: NY 246675) | |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2024-08-12 |