| NPI | 1912265869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 007652) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 28861) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2018-09-12 |