| NPI | 1104981679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA05170900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 1572891) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2015-08-13 |