| NPI | 1801889761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NH 19700) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 260251) |
| 207X00000X Orthopaedic Surgery (Licence: VT 042.0012673) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MA 57227) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VT 042.0012673) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2020-01-24 |