| NPI | 1528448115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MB12482000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016360) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2025-11-24 |