| NPI | 1003112244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NJ 25MA09848600) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 261137) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2017-04-06 |