| NPI | 1023046521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME90952) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10203200) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-02-13 |