| NPI | 1346667342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056670) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MP00329000) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2021-04-13 |