| NPI | 1891225405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 74012) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 314770) |
| 207X00000X Orthopaedic Surgery (Licence: PA MT214221) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-04-25 |