| NPI | 1871932533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 297745) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: VA 0101263850) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 297745) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-12-01 |