| NPI | 1194102699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: TX BP10053946) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10754400) |
| 208D00000X General Practice (Licence: NJ 25MA10754400) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2020-07-24 |