| NPI | 1447548813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: NY 014847) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-03-07 |