| NPI | 1356729602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MB12013600) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 289325) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2024-01-30 |