| NPI | 1790737377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 042957) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MB08046600) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 223598) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-02-24 |