| NPI | 1992039044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 261002) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD438358) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2022-08-11 |