| NPI | 1568653947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 226162) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09352900) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2020-12-30 |