| NPI | 1902334063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 315468) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301111854) |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NY 315468) | |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2023-03-09 |