| NPI | 1093374340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID 3771654) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 67861) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12096900) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2025-06-30 |