| NPI | 1659240893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY O000272-01) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: NY O000272-01) |
| Enumeration Date | 2025-11-04 |
| Last Update Date | 2025-11-04 |