| NPI | 1427095868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 006928) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 005015) |
| 363A00000X Physician Assistant (Licence: NY 006928) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-03-23 |