| NPI | 1679102909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA MD488419) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12570300) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2026-06-08 |