| NPI | 1336183466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 000933-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 000933) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-05-18 |