| NPI | 1881131910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 020569) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NY 020569) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2019-07-25 |