| NPI | 1023379203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 268312-1) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 21976) |
| 207X00000X Orthopaedic Surgery (Licence: NY 268312-1) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA09281400) | |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09281400) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2017-01-27 |