| NPI | 1992899868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 207208) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 207208) |
| 207X00000X Orthopaedic Surgery (Licence: NY 207208) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-01-25 |