| NPI | 1972504538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 125746) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NY 125746) |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: NY 125746) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 125746) | |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2014-08-07 |