| NPI | 1609312156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 024459) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2021-03-30 |