| NPI | 1285671065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD068498L) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA06942500) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MA 73829) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-02-18 |