| NPI | 1851619100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NJ 25MA09854900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MT197064) |
| 207X00000X Orthopaedic Surgery (Licence: NJ 25MA09854900) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2023-11-20 |