| NPI | 1588867790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 64100) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09153900) |
| 207X00000X Orthopaedic Surgery (Licence: PA mt186772) | |
| 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery (Licence: NJ 25MA09153900) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2019-08-14 |