| NPI | 1801246798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 317210) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT017024) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-07-11 |