| NPI | 1265152904 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 028810) |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2022-09-01 |