| NPI | 1649764580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12093200) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT215944) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-08-12 |