| NPI | 1457531121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 009211) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 009211-1) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2011-02-28 |