| NPI | 1013037357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3830) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010398) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-09-10 |