| NPI | 1417356825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0005476) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 026100) |
| 363A00000X Physician Assistant (Licence: PA MA056918) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA OA003308) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA056918) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 026100) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2022-03-09 |