| NPI | 1396140661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 018157) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2015-07-21 |