| NPI | 1649923038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 028067) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 028067) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2023-05-31 |