| NPI | 1639148208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 202532) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery (Licence: NY 202532) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA09393500) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-11-07 |