| NPI | 1669795498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25mb09631600) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA OT013754) |
| 207X00000X Orthopaedic Surgery (Licence: PA OS016759) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2015-06-01 |