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 |