| NPI | 1235455924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09902700) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 272553) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2016-07-20 |