| NPI | 1821251125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: OR MD157386) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 249195-1) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2019-06-10 |