| NPI | 1124025473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 008055) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: NY 008055-1) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 008005) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2025-11-22 |