| NPI | 1487067872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA11207000) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA 31705228) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2023-01-18 |