| NPI | 1043595911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015383-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9119112) |
| 363AS0400X Physician Assistant Surgical (Licence: NY 015383-1) | |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2024-08-27 |