| NPI | 1255699542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NJ 25MP00603900) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 016892-01) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA22064) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2024-04-18 |