| NPI | 1407186190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002389) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 0094491) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2014-12-29 |