| NPI | 1063723666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 014125) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY Pending) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2022-10-18 |