| NPI | 1356349484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09195900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD019408E) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-01-27 |