| NPI | 1639432933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10643900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 252129) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2019-09-30 |