| NPI | 1508326760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MB12668100) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 340681) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2025-08-13 |