| NPI | 1912293283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09908500) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC LL33888) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2019-04-16 |