| NPI | 1538217393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103198) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 001565) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-10-30 |