| NPI | 1619102373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 015603) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104969) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2024-09-19 |