| NPI | 1275633059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0003093) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 010285) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2008-07-08 |