| NPI | 1073583746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MAO7423500) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 218115) |
| 207X00000X Orthopaedic Surgery (Licence: NH 12006) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA07423500) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2026-02-18 |