| NPI | 1194790535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NJ 25MA06579400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA65794) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2019-07-22 |