| NPI | 1689810731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA09047800) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09047800) |
| 207X00000X Orthopaedic Surgery (Licence: PA mt186285) | |
| Enumeration Date | 2008-12-19 |
| Last Update Date | 2025-10-08 |