| NPI | 1588646525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 185606) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA04588600) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2017-05-11 |