| NPI | 1134642309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: NY 21176) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-06-29 |