| NPI | 1578683041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104151) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 003794) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2014-12-17 |