| NPI | 1669606240 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 281587) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 281587-1) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10500400) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA10500400) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2021-03-05 |