| NPI | 1700022043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MA 249143) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT185337) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09198900) | |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2013-05-17 |