| NPI | 1790724334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 210360) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 210360) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-01-23 |