| NPI | 1376590646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA08970900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME0065564) |
| 207X00000X Orthopaedic Surgery (Licence: NY 265913-1) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD459089) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-04-22 |