| NPI | 1467490680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 007870) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 0078701) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-02-10 |