| NPI | 1144658337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MB09875400) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MB09875400) |
| 208000000X Pediatrics (Licence: DE C20011742) | |
| 208000000X Pediatrics (Licence: PA OS016839) | |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2017-04-25 |