| NPI | 1437340122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 011598) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MP00625600) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 011598) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2025-11-06 |