| NPI | 1811992746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA05250300) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NJ 25MA05250300) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2020-06-14 |