| NPI | 1881913622 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09692400) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 275010) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2023-12-22 |