| NPI | 1275616070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 090042) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 090042) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2019-10-02 |