| NPI | 1205399888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD482366) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12528000) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-08-01 |