| NPI | 1245484203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA3757) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 012949-1) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2011-03-17 |