| NPI | 1861948218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 019883) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NJ 25MP00654600) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2025-10-07 |