| NPI | 1295796977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL FLAME0148598) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA04184700) |
| 208D00000X General Practice (Licence: FL FLAME0148598) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-09-13 |