| NPI | 1316489263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 0203821) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 020382) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2025-11-18 |