| NPI | 1396941050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 011865-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011865-4) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-01-06 |