| NPI | 1487159059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023032) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PA9111037) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2020-08-12 |