| NPI | 1457440208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0012053) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 008516) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2024-10-29 |