| NPI | 1730140153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD063274L) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME152450) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA09456000) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 307192) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2022-02-18 |