| NPI | 1952863946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 336964) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 336964) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-07-17 |