| NPI | 1720549397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA12727000) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 1018963) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-07-07 |