| NPI | 1962408856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA06567900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD047822L) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2021-04-07 |