| NPI | 1255778189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL 0064060) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ MA 032823) |
| 207X00000X Orthopaedic Surgery (Licence: NC 97-00430) | |
| Enumeration Date | 2013-06-01 |
| Last Update Date | 2013-06-01 |