| NPI | 1952696304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 288778) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT200727) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2019-03-11 |