| NPI | 1023569431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 020185) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NY 20185) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 020185) | |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2023-06-29 |