| NPI | 1124461033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: SC 84826) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10577800) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2021-07-08 |