| NPI | 1588773758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA05232100) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA52321) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-03-04 |