| NPI | 1053743682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 257157) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00395600) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2025-07-17 |