| NPI | 1205128220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09812300) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD456607) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2019-04-02 |