| NPI | 1134468812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA065792) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 016374) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2024-09-13 |