| NPI | 1871170233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MN 81955) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 320376-01) |
| 207X00000X Orthopaedic Surgery (Licence: NY pending) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-07-09 |