| NPI | 1811151947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 245467) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A103640) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 245467) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2011-01-25 |