| NPI | 1811979487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 169890) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 169890) |
| 207X00000X Orthopaedic Surgery (Licence: WI 18247) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2018-03-28 |