| NPI | 1487703898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 004793-1) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 004793) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-08-19 |