| NPI | 1295037356 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MB09864600)  | 
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT013552)  | 
| Enumeration Date | 2010-11-23 | 
| Last Update Date | 2018-03-17 |