| NPI | 1003913807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 203677-1) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 230677-1) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA07243300) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA07243300) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-06-06 |