| NPI | 1356837702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 022149-1) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 022149-1) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-10-19 |