| NPI | 1366087082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9116836) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00560200) |
| 363A00000X Physician Assistant (Licence: FL PA9116836) | |
| 363A00000X Physician Assistant (Licence: NY 024326) | |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2023-08-02 |