| NPI | 1245582717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016097) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 016097) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2023-05-08 |