| NPI | 1982098992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 320184) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 66649) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2023-05-10 |