| NPI | 1023109121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA05804400) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 168100-2) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |