| NPI | 1871215814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00734300) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MP00734300) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00734300) | |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2022-09-15 |