| NPI | 1336356021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ MA08983100) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD430687) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-08-13 |