| NPI | 1619740388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MP00814300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MP00814300) |
| 261QU0200X Clinic/Center, Urgent Care (Licence: NJ 25MP00814300) | |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-09-26 |