| NPI | 1336509553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 019538) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 019538) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2019-05-17 |