| NPI | 1952734311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0101266862) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MA10307900) |
| 207X00000X Orthopaedic Surgery (Licence: PA MD457187) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD457187) | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2019-07-15 |