| NPI | 1477162725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 025426) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2022-10-05 |