| NPI | 1467504993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 23-009726) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CT 002215) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-04-11 |