| NPI | 1952377251 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 009484-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 9484) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2023-07-06 |