| NPI | 1649423146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 238123) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA08490300) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2013-04-04 |