| NPI | 1598871162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA06863800) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD432593) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA06863800) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME153072) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 303724) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-03-01 |