| NPI | 1578983698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 298894) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 298894) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2023-07-22 |