| NPI | 1962829309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 110940) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 297159) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2026-07-01 |