| NPI | 1932542701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CA 187384) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.125618) |
| 208D00000X General Practice (Licence: NY 288924) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2023-06-26 |