| NPI | 1164595534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 147827) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA08297300) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2009-05-26 |