| NPI | 1548279961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 224551-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA081052) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2019-03-06 |