| NPI | 1417124512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD437725) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 234218) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA09220100) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME152689) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2022-02-15 |