| NPI | 1417960063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NJ 25MA06365500) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA06365500) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-01-20 |