| NPI | 1851409627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 211624) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 211624) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 211624) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-03-18 |