| NPI | 1750823464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 020179-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 020179-1) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2024-10-30 |