| NPI | 1700556982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 027626) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY NA) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-11-18 |