| NPI | 1689655920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 175801-1) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 175801-1) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA05223700) | |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2019-01-09 |