| NPI | 1588203806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 024428) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2022-03-07 |