| NPI | 1710921887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD028153E) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA05592700) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-02-18 |