| NPI | 1306878038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 008132) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 8132) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-07-06 |