| NPI | 1265801591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 018986) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00542200) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2024-01-02 |