| NPI | 1457440711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA08081500) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 222942) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 43425) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-03-22 |