| NPI | 1164428009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD042290E) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA40055) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2021-06-02 |