| NPI | 1437983962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 032278-01) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 032278-01) |
| 363AM0700X Physician Assistant Medical (Licence: NY 032278-01) | |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-28 |