| NPI | 1558308247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA MD436798) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD D0033057) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NJ 25MA09189900) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2015-11-10 |