| NPI | 1538134119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA003059L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008090-1) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-03-05 |